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. 2022 Aug 27;21(1):164.
doi: 10.1186/s12933-022-01598-2.

Role of continuous glucose monitoring in diabetic patients at high cardiovascular risk: an expert-based multidisciplinary Delphi consensus

Carlo Di Mario  1 , Stefano Genovese  2 , Gaetano A Lanza  3 , Edoardo Mannucci  4 , Giancarlo Marenzi  5 , Edoardo Sciatti  6 , Dario Pitocco  7 ; Expert Panel Group
Collaborators, Affiliations

Role of continuous glucose monitoring in diabetic patients at high cardiovascular risk: an expert-based multidisciplinary Delphi consensus

Carlo Di Mario et al. Cardiovasc Diabetol. .

Abstract

Background: Continuous glucose monitoring (CGM) shows in more detail the glycaemic pattern of diabetic subjects and provides several new parameters ("glucometrics") to assess patients' glycaemia and consensually guide treatment. A better control of glucose levels might result in improvement of clinical outcome and reduce disease complications. This study aimed to gather an expert consensus on the clinical and prognostic use of CGM in diabetic patients at high cardiovascular risk or with heart disease.

Methods: A list of 22 statements concerning type of patients who can benefit from CGM, prognostic impact of CGM in diabetic patients with heart disease, CGM use during acute cardiovascular events and educational issues of CGM were developed. Using a two-round Delphi methodology, the survey was distributed online to 42 Italian experts (21 diabetologists and 21 cardiologists) who rated their level of agreement with each statement on a 5-point Likert scale. Consensus was predefined as more than 66% of the panel agreeing/disagreeing with any given statement.

Results: Forty experts (95%) answered the survey. Every statement achieved a positive consensus. In particular, the panel expressed the feeling that CGM can be prognostically relevant for every diabetic patient (70%) and that is clinically useful also in the management of those with type 2 diabetes not treated with insulin (87.5%). The assessment of time in range (TIR), glycaemic variability (GV) and hypoglycaemic/hyperglycaemic episodes were considered relevant in the management of diabetic patients with heart disease (92.5% for TIR, 95% for GV, 97.5% for time spent in hypoglycaemia) and can improve the prognosis of those with ischaemic heart disease (100% for hypoglycaemia, 90% for hyperglycaemia) or with heart failure (87.5% for hypoglycaemia, 85% for TIR, 87.5% for GV). The experts retained that CGM can be used and can impact the short- and long-term prognosis during an acute cardiovascular event. Lastly, CGM has a recognized educational role for diabetic subjects.

Conclusions: According to this Delphi consensus, the clinical and prognostic use of CGM in diabetic patients at high cardiovascular risk is promising and deserves dedicated studies to confirm the experts' feelings.

Keywords: Cardiovascular outcome; Continuous glucose monitoring; Delphi method; Glucometrics; Glycaemic variability; Time in range.

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Conflict of interest statement

all authors report personal fees from Abbott Diabetes Care, during the conduct of the study. S.G. reports personal fees from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Hikma Pharmaceuticals, Merck Sharp & Dhome, Molteni Farmaceutici, Novartis, Novo Nordisk, Sanofi, Takeda, Teva, Zentiva, outside the submitted work.

Figures

Fig. 1
Fig. 1
Description of the Delphi process
Fig. 2
Fig. 2
Geographic distribution of respondents
See this image and copyright information in PMC

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